First let me say that one of the most common things that causes chronic red eye
is when someone uses eye drops with a redness reliever component in them. These get-the-red-out drops are useful to decrease redness in an eye on a short-term basis; however, when they are used chronically, over many weeks to months, the eyes can get habituated to them, and more and more of the drop is required to keep the eye from being red. Therefore, the eye tends to stay red regardless of how much of that drop is used. For this reason, I think it is appropriate only to use those kinds of drops for a few days at a time only.
If the redness-reliever drop has been used for a long time, it will take awhile for the effects of the drops to "wash out", so to speak. The longer the duration that the drops were used, the longer the duration away from the drops is necessary for the redness to disappear. For some, it can disappear in 4-6 weeks after having stopped these drops. For people who have taken them for years, it can take several months to wash out.
Aside from the use of these redness-reliever drops, the most common reason for chronic red eye is an inflammation of the eyelids called blepharitis
. It is so incredibly common and can come in many different varieties, severities, and presentations. It can cause any of the following symptoms: burning, itching, discharge, tearing
, dry or gritty feeling, foreign-body sensation, light-sensitivity, redness, pain and/or blurry vision
. For some who have blepharitis, they don't have any of these symptoms but can still have the inflammation. Because this is so incredibly common and also because I can't examine you, I would recommend starting the treatment for blepharitis.
In order to treat blepharitis, everyday in the morning you should do two things: 1. hot compresses and 2. eyelid scrubs. You should do hot compresses for 5-10 minutes over each eye at the same time. It should be as hot as you can tolerate without burning your skin, massaging the eyelids while they are on there. Then, use either commercially available preparations or a dilute baby shampoo solution to scrub your eyelashes on all 4 eyelids. The commercially available preparations are called Ocusoft or Sterilid which are both over-the-counter eyelash scrubbing treatments. These cost more money but are quicker to use. Otherwise, the cheaper alternative is the dilute baby shampoo (4-5 drops Johnson's shampoo in 1/4 cup warm water), you will take the wipe (or dip a qtip in the dilute baby shampoo solution) and use that to scrub right on the eyelashes of each eyelid for 15 seconds. That will take 60 seconds when done to all 4 eyelids. The scrubbing is done right on the eyelid margin, where the eyelashes come out. After that, just splash some water on the eyes and you're done. It does take about 3-4 weeks of doing this consistently every day before it really kicks in, so don't stop it thinking it's not working. Also the eyes are still significantly dry during this 3-4 weeks so use the artificial tears you bought 4x/day in both eyes (one drop per application). After 4 weeks you should be able to start tapering off of the tears to as you need them. Any artificial tear without this redness-reliever chemical in them should be fine; some brand name examples that my patients like using are Refresh, Systane, Blink, Optive. Just doing the artificial tears, hot compresses and eyelid scrubs alone would likely start to help you after three or 4 weeks--but remember it could take this long of doing it everyday before you see a significant effect, so don't stop it thinking it's not working. There are many reasons for dry eye besides blepharitis that one person can have at the same time. If you are a person that doesn't make their own tears very well, then you may also benefit from a prescription drop called Restasis, which actually modulates a person's immune system to help them make more of their own tears. This drop actually requires constant usage on a daily basis for up to 10-12 weeks before its effect kicks in (takes awhile to change the immune response in the body). You may also need an antibiotic/steroid combination drop if the inflammation has not significantly calmed down after 2-3 weeks.
Ultimately, though, if you've done all of this and there has been no resolution to the redness, it's possible that there is an ongoing issue that is causing your eyes to still be red. Any foreign-body (something that may have gotten in the eye) or exposure to a chemical that doesn't belong in the eye (cleaners, lotions, medicines, or fumes/vapors) can cause an inflammation in the eye which causes the eye to be bloodshot. Other types of inflammation include allergic conjunctivitis (allergies in the eyes), dry eye or dysfunctional tear film
syndrome (this is one of the most common reasons), a lack of sleep, over-use of the eyes, a reaction to alcohol or drug use, inflammations inside the eye (called iritis), corneal abrasions
(scratches), or infections of the eye such as herpes or bacterial infections.
If this still persists I would recommend seeing a corneal specialist for an evaluation as this is precisely the sub specialist who has the most expertise with diagnosing these issues.
Does this make sense? Does this information help address your concerns? Do you have any other questions about this?
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My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry!